Provider Demographics
NPI:1295756310
Name:GOLDEN VALLEY MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:GOLDEN VALLEY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-664-0252
Mailing Address - Street 1:4813 COFFEE RD
Mailing Address - Street 2:#200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-9472
Mailing Address - Country:US
Mailing Address - Phone:661-664-0252
Mailing Address - Fax:661-664-2717
Practice Address - Street 1:4813 COFFEE RD
Practice Address - Street 2:#200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-9472
Practice Address - Country:US
Practice Address - Phone:661-664-0252
Practice Address - Fax:661-664-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25181ZOtherMEDICARE GROUP #